Racial disparities in access to high quality cardiac surgeons among the elderly Racial disparities in access to health care services is a well documented, if poorly understood, persistent characteristic of the American health care system. Inadequate access to services by racial minorities, as it leads to poor health outcomes and poor health, has become an important part of our national health policy agenda. Racial minorities have been shown to be less likely to receive cardiac surgery. Even when they gain access to surgery, they are still disadvantaged because they access surgeons with higher risk-adjusted mortality rates (RAMR), compared to whites. These issues are of particular importance to the elderly population, as heart disease is one of the major morbidities in this population, it is the leading cause of death and over 50% of CABG surgeries are performed on individuals aged 65 and older. The proposed study is designed to test specific hypotheses about the factors contributing to the observed disparities in access to high quality cardiac surgeons. It will test hypotheses related to three referral decisions foci: the patient, the referring physician and the managed care organization (MCO). The population studied will include all Medicare patients undergoing CABG surgery, all cardiac surgeons and hospitals in NYS. Medicare CABG patients will be surveyed about their use of RAMR information and their encounter with the referring physician. Medicare claims for medical care encounters prior to the surgery will be used to analyze referral patterns. NYS SPARCS data and MCO information, as well as a unique data set with information about contracting patterns of MCOs with hospitals and cardiac surgeons, will be used to study the effect of MCOs on racial disparities in access. Statistical multivariate regression techniques will be used to analyze the data. The knowledge gained in this project is essential for development of targeted programs that could successfully address the disparity in access to high quality cardiac care among elderly racial minorities.